SHEK 3301- CANCER BIOLOGY

Pathology of Cancer
Pathology
Diagnosis
Prognosis
Identifying features
Methods
Pathology-Branch
Histopathology: microscopic examination of biological tissues to observe the
appearance of diseased cells and tissues in very fine detail.
Cytology: The medical and scientific study of individual cells.
Chemical pathology: analysis of tissues, blood and urine
e.g. to distinguish between benign and malignant cells
Benign are not usually life-threatening and therefore treatments of the two types of growth
are different.

Pathology of Cancer/RS/SHEK3301-2-2014/15

Malignancy is usually characterized by various behavioural features, most notably:

Invasion
The capacity to infiltrate the surrounding tissues and organs.
Metastasis
The ability to proliferate in distant parts of the body, after tumour cells have been
transported by lymph or blood or along body spaces.

Pathology of Cancer/RS/SHEK3301-2-2014/15

Diagnosis
Is it cancer?
What type of cancer? Histogenesis
e.g. to determine the cellular origin of a cancer (histogenesis)
Cancer in an organ can have several origins.
Thus, in lung, smoking generates epithelial cancers whereas mesothelial cancers
result from asbestos exposure.
As treatments are different, the importance of determining histogenesis is clear.
Cancers are described according to their cell of origin and the tissue in which they arise.
Epithelium (Carcinoma)
The type of epithelium is additionally identified.
Glandular epithelium generates an adenocarcinoma. (e.g. prostate adenocarcinoma)
A cancer of squamous epithelium would be a squamous cell carcinoma. (e.g. cervical
squamous cell carcinoma)
Mesenchyme (sarcoma)
Smooth muscle: leiomyosarcoma
Bone: osteosarcoma

Pathology of Cancer/RS/SHEK3301-2-2014/15

Nervous system
Eye: retinoblastoma
Astrocytes: astrocytoma
White blood cells (leukaemia)
Leukaemias are further defined according to the speed with which they develop.
Acute myeloid leukaemia (AML) exhibit rapid onset of symptoms.
Chronic myeloid leukaemia (CML) exhibit slow onset of symptoms.
For historical reasons, some cancers are named after their discoverers:

Burkitts lymphoma is a B-lymphocyte cancer

Wilms tumour is a renal carcinoma in young children

Kaposis sarcoma arises from endhothelial cells of blood vessels.

Identifying features
Cell and tissue architecture.
Differentiation: degree it resembles normal.
Cell structure: nucleus, mitosis, nuclear/cytoplasmic ratio.
Localised (in situ)or invasive (stroma, blood vessels)

Pathology of Cancer/RS/SHEK3301-2-2014/15

In situ or Invasive
An early stage cancer in which the cancerous growth or tumour is still confined to
the site from which it started, and has not spread to surrounding tissue or other
organs in the body.
When cancer in situ involves cells that line the internal organs, or epithelial cells, it is
called carcinoma in situ.
Tumours, on the other hand, which exhibit all the microscopic features of cancers
but do not breach the original basement membrane, are termed in situ (noninvasive) cancers.
Invasive: Cancer that has spread beyond the layer of tissue in which it developed
and is growing into surrounding, healthy tissues.

The progression begins with a mutation that makes the cell more likely to divide.
The altered cell and its descendants grow and divide too often, a condition
called hyperplasia.
At some point, one of these cells experiences another mutation that further
increases its tendency to divide; this cell's descendants divide excessively and look
abnormal, a condition called dysplasia.

Pathology of Cancer/RS/SHEK3301-2-2014/15

 As time passes, one of the cells experiences yet another mutation, causing very
abnormal structure, loss of differentiation, and loss of contact between the cells;
however, it is still confined to the epithelial layer from which it arose, so it is called
a cancer in situ.
The in situ cancer may remain contained indefinitely, but additional mutations may
occur that enable it to invade neighbouring tissues and shed cells into the blood or
lymph, the tumour is said to be an invasive cancer (malignant).
The escaped cells may establish new tumours (metastases) at other locations in the
body.

Methods
Staining
Immunohistochemistry: protein
In situ hybridisation: mRNA
Routine H&E staining and special stains play a critical role in tissue-based diagnosis
or research.
By colouring otherwise transparent tissue sections, these stains allow highly trained
pathologists and researchers to view, under a microscope, tissue morphology
(structure) or to look for the presence or prevalence of particular cell types,
structures or even microorganisms such as bacteria.
Pathology of Cancer/RS/SHEK3301-2-2014/15

 The term special stains traditionally referred to any staining other than an H&E.

In situ hybridization (ISH) is a powerful technique for localizing specific nucleic acid
targets within fixed tissues and cells, allowing you to obtain temporal and spatial
information about gene expression and genetic loci.

Pathology of Cancer/RS/SHEK3301-2-2014/15